chapter 22 urinary elimination copyright © 2012 by mosby, an imprint of elsevier inc. all rights...

Chapter 22Chapter 22

Urinary EliminationUrinary Elimination

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary EliminationUrinary Elimination

Eliminating waste is a physical need.Eliminating waste is a physical need. Common terms include: urination, Common terms include: urination,

micturitionmicturition, voiding, peeing, passing , voiding, peeing, passing water, making waterwater, making water

The urinary system:The urinary system: Removes waste products from the bloodRemoves waste products from the blood Maintains the body’s water balanceMaintains the body’s water balance

Slide 2Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary SystemUrinary System

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved. Slide 3

The healthy adult produces about 1500 mL The healthy adult produces about 1500 mL (milliliters), or 3 pints, of urine a day.(milliliters), or 3 pints, of urine a day.

Factors affecting urine production include:Factors affecting urine production include: AgeAge DiseaseDisease Amount and kinds of fluid ingestedAmount and kinds of fluid ingested Dietary saltDietary salt Body temperature and perspirationBody temperature and perspiration DrugsDrugs

Frequency of urination is affected by:Frequency of urination is affected by: Amount of fluid intake, habits, and available toilet facilitiesAmount of fluid intake, habits, and available toilet facilities Activity, work, and illnessActivity, work, and illness


Normal UrinationNormal Urination

Normal Urination (cont’d)Normal Urination (cont’d)

ObservationsObservations Normal urine:Normal urine:

• Is pale yellow, straw-colored, or amberIs pale yellow, straw-colored, or amber• Is clear with no particlesIs clear with no particles• Has a faint odorHas a faint odor

Observe urine for color, clarity, odor, Observe urine for color, clarity, odor, amount, particles, and blood.amount, particles, and blood.

Report complaints of urgency, burning on Report complaints of urgency, burning on urination, or painful or difficult urination-urination, or painful or difficult urination-may signal kidney stones etc.may signal kidney stones etc.


UrineUrine


Kidney StonesKidney Stones


Urinary ProblemsUrinary Problems

Dysuria-difficult or painful (dys) Dysuria-difficult or painful (dys) urination (uria)urination (uria)

Nocturia-frequent urination (uria) at Nocturia-frequent urination (uria) at night (noct)night (noct)

Hematuria-blood (hemat) in the urine Hematuria-blood (hemat) in the urine (uria)(uria)

Oliguria-scant amount (olig) or urine Oliguria-scant amount (olig) or urine (uria)(uria)


Bedpans are used by:Bedpans are used by: Persons who cannot be out of bedPersons who cannot be out of bed Women for voiding and bowel movementsWomen for voiding and bowel movements Men for bowel movementsMen for bowel movements

Standard bedpans and fracture pans are Standard bedpans and fracture pans are used.used. Fracture pans are used by patients with:Fracture pans are used by patients with:

• Casts, in traction, limited back movement Casts, in traction, limited back movement • After spinal cord injury, surgeryAfter spinal cord injury, surgery• After a hip fracture or replacement After a hip fracture or replacement



Men use urinals to voidMen use urinals to void.. The man stands if possible.The man stands if possible. Some sit on the side of the bed or lie in bed.Some sit on the side of the bed or lie in bed. Some men need support when standing.Some men need support when standing. You may have to place and hold the urinal for You may have to place and hold the urinal for

some men.some men. Remind men:Remind men:

To hang urinals on bed rails and signal after useTo hang urinals on bed rails and signal after use Not to place urinals on overbed tables and Not to place urinals on overbed tables and

bedside standsbedside stands



Persons unable to walk to the bathroom often Persons unable to walk to the bathroom often use bedside commodes.use bedside commodes. The commode allows a normal position for The commode allows a normal position for

elimination.elimination. The commode arms and back provide support and The commode arms and back provide support and

help prevent falls.help prevent falls. Some commodes are wheeled into bathrooms and Some commodes are wheeled into bathrooms and

placed over toilets. They are useful for persons placed over toilets. They are useful for persons who need support when sitting or need an who need support when sitting or need an elevated seat.elevated seat.



Urinary IncontinenceUrinary Incontinence

The basic types of incontinence are:The basic types of incontinence are: StressStress UrgeUrge OverflowOverflow FunctionalFunctional ReflexReflex Mixed incontinenceMixed incontinence Transient incontinenceTransient incontinence

If incontinence is a new problem, tell the If incontinence is a new problem, tell the nurse at once.nurse at once.


The following may be needed:The following may be needed: Good skin care and dry garments and linensGood skin care and dry garments and linens Promoting normal urinary eliminationPromoting normal urinary elimination Bladder trainingBladder training CathetersCatheters

Incontinence is linked to abuse, mistreatment, Incontinence is linked to abuse, mistreatment, and neglect.and neglect. Remember, incontinence is beyond the person’s Remember, incontinence is beyond the person’s

control.control. If you are becoming short-tempered and impatient, If you are becoming short-tempered and impatient,

talk to the nurse at once.talk to the nurse at once. The person has the right to be free from abuse, The person has the right to be free from abuse,

mistreatment, and neglect.mistreatment, and neglect.Slide 13Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Urinary Incontinence (cont’d)Urinary Incontinence (cont’d)

Catheters Catheters

Inserted through the urethra into the bladder, Inserted through the urethra into the bladder, a urinary catheter drains urine into a a urinary catheter drains urine into a drainage bag.drainage bag.

A straight catheter drains the bladder and A straight catheter drains the bladder and then is removed.then is removed.

An indwelling catheter (retention or Foley An indwelling catheter (retention or Foley catheter) is left in the bladder.catheter) is left in the bladder. Catheterization is the process of inserting a Catheterization is the process of inserting a

catheter.catheter.


Catheters are used:Catheters are used: Before, during, and after surgeryBefore, during, and after surgery For people who are too weak or disabled to use For people who are too weak or disabled to use

the bedpan, urinal, commode, or toiletthe bedpan, urinal, commode, or toilet To protect wounds and pressure ulcers from To protect wounds and pressure ulcers from

contact with urinecontact with urine To allow hourly urinary output measurementsTo allow hourly urinary output measurements To collect sterile urine specimensTo collect sterile urine specimens For measuring residual urineFor measuring residual urine

When caring for persons with indwelling When caring for persons with indwelling catheters, the risk of infection is high.catheters, the risk of infection is high.


Catheters (cont’d) Catheters (cont’d)

Drainage systemsDrainage systems A closed drainage system is used for indwelling A closed drainage system is used for indwelling

catheters.catheters.• Nothing can enter the system from the catheter to the Nothing can enter the system from the catheter to the

drainage bag.drainage bag.

Some people wear leg bags that attach to the Some people wear leg bags that attach to the thigh or calf when standing up.thigh or calf when standing up.

The drainage bag is always kept lower than the The drainage bag is always kept lower than the bladder to prevent urinary tract infections (UTIs).bladder to prevent urinary tract infections (UTIs).

The catheter bag is attached to the bed frame The catheter bag is attached to the bed frame when the patient is in bed.when the patient is in bed.



If the drainage system is disconnected If the drainage system is disconnected accidentally, tell the nurse at once. accidentally, tell the nurse at once. Do not touch the ends of the catheter or tubingDo not touch the ends of the catheter or tubing.. Practice hand hygiene and put on gloves.Practice hand hygiene and put on gloves. Wipe the end of the tube with an antiseptic wipe.Wipe the end of the tube with an antiseptic wipe. Wipe the end of the catheter with another antiseptic wipe.Wipe the end of the catheter with another antiseptic wipe. Do not put the ends down.Do not put the ends down.

• Do not touch the ends after you clean them.Do not touch the ends after you clean them. Connect the tubing to the catheter.Connect the tubing to the catheter. Discard the wipes into a biohazard bag.Discard the wipes into a biohazard bag. Remove the gloves and practice hand hygiene.Remove the gloves and practice hand hygiene.



Leg bags are changed to drainage bags when Leg bags are changed to drainage bags when the person is in bed.the person is in bed.

You open the closed drainage system.You open the closed drainage system.• Prevents microbes from entering the system.Prevents microbes from entering the system.

Drainage bags are emptied and urine is Drainage bags are emptied and urine is measured:measured:• At the end of every shiftAt the end of every shift

• When changing from a leg bag to a drainage bagWhen changing from a leg bag to a drainage bag

• When changing from a drainage bag to a leg bagWhen changing from a drainage bag to a leg bag

• When the bag is becoming fullWhen the bag is becoming full

• Nothing should touch the drain when emptying!Nothing should touch the drain when emptying!



Removing indwelling cathetersRemoving indwelling catheters An indwelling catheter has two lumens (passage-An indwelling catheter has two lumens (passage-

ways).ways).• Sterile water is injected through one lumen to inflate the Sterile water is injected through one lumen to inflate the

balloon.balloon.

• Urine drains from the bladder through the other lumen.Urine drains from the bladder through the other lumen.

A physician’s order is needed to remove a catheter.A physician’s order is needed to remove a catheter. Most people need bladder training first-the purpose Most people need bladder training first-the purpose

is to regain control of urinationis to regain control of urination Dysuria and urinary frequency are common after Dysuria and urinary frequency are common after

removing catheters.removing catheters.



Condom catheters (external catheters, Texas Condom catheters (external catheters, Texas catheters, urinary sheaths) are often used for catheters, urinary sheaths) are often used for incontinent men.incontinent men. A condom catheter is a soft sheath that slides A condom catheter is a soft sheath that slides

over the penis.over the penis. To apply a condom catheter:To apply a condom catheter:

• Follow the manufacturer’s instructions.Follow the manufacturer’s instructions.• Thoroughly wash the penis with soap and water.Thoroughly wash the penis with soap and water.• Dry the penis before applying the catheter.Dry the penis before applying the catheter.

Condom catheters are self-adhering or applied Condom catheters are self-adhering or applied with elastic tape.with elastic tape.• Never use adhesive tape to secure catheters.Never use adhesive tape to secure catheters.



Condom catheterCondom catheter


Control of urination is the goal.Control of urination is the goal. The person uses the toilet, commode, bedpan, The person uses the toilet, commode, bedpan,

or urinal at certain times.or urinal at certain times. The rules for normal elimination are followed.The rules for normal elimination are followed. The normal position for urination is assumed if The normal position for urination is assumed if

possible.possible. Privacy is important.Privacy is important. Four methods are:Four methods are:

Bladder retrainingBladder retraining Prompted voidingPrompted voiding Habit training/scheduled voidingHabit training/scheduled voiding Catheter clampingCatheter clamping


Bladder TrainingBladder Training

chapter 22 urinary elimination copyright © 2012 by mosby, an imprint of elsevier inc. all rights...

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